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Trevor Bedford
Trevor Bedford, an epidemiologist at Seattle’s Fred Hutchinson Cancer Center, has outlined a three-part strategy for knocking down the coronavirus outbreak. (Fred Hutch Photo)

A Seattle epidemiologist who warned about the threat posed by novel coronavirus when it was a novelty now says he sees a path to stopping the pandemic.

But it’ll take more than just staying at home for a couple of weeks, Trevor Bedford of the Fred Hutchinson Cancer Research Center said today in a series of tweets.

“This is the Apollo program of our times,” Bedford wrote.

Bedford, who analyzed genetic data to figure out that the SARS-CoV-2 coronavirus had been spreading stealthily in the U.S. for six weeks, began with the standard advice on social distancing.

Although social distancing can “flatten the curve,” a recently published study found that the strategy isn’t likely to bring an end to the outbreak by itself. There’s a good chance that the outbreak would rebound once the restrictions were relaxed.

The study, led by researchers at Imperial College London, concluded that stringent social distancing would have to be maintained until a vaccine is developed – which could take 18 months or more. And the financial cost of maintaining the strategy that long may be unacceptably steep.

“This is the catch-22 as presented by the report,” Bedford tweeted.

Is there a way out? “I have hope that we can solve this thing by doing traditional shoe leather epidemiology of case finding and isolation, but at scale, using modern technology,” Bedford said.

The first part of the strategy depends on a massive campaign of testing, followed by isolation for those who test positive. “If someone can be tested early in their illness before they show symptoms, they could effectively self-isolate and reduce onward transmission, compared to isolation when symptoms develop,” Bedford explained.

He noted that such a strategy appears to be working in South Korea.

Getting enough tests has proven to be a problem in the U.S., and that’s where Bedford’s Apollo program comes into play.

“This rollout of testing could be achieved through at-home delivery of swabs with centralized lab-based processing, combined with drive-through testing facilities,” Bedford said. “There are logistics involved in getting a result quickly, but it’s really just logistics.”

Plans for at-home sampling have surfaced a couple of times this month: The White House’s plan to increase coronavirus testing envisions having LHC Group, a home healthcare services company, play a part in facilitating at-home testing.

Even before the White House unveiled its plan, there was talk of the Bill & Melinda Gates Foundation and Amazon Care teaming up on a home testing system.

Regardless of who does it, an at-home testing campaign would be costly and complicated. But as Bedford says, it’s really just logistics.

The second part of the strategy involves using cellphone location data. Once a person tests positive, all the people who came into close contact with that person before the test results were available – as determined by matching up location data – would be alerted to get tested and go into self-isolation.

Bedford noted that Oxford epidemiologist Christophe Frazer and his colleagues have already looked into how such an instant-tracing strategy could work.

“A third, supporting, strategy: As the epidemic proceeds, get serological assays run on as many people as possible to systematically identify individuals who have recovered and are highly likely to possess immunity,” Bedford wrote. “Individuals who have serological evidence of recovery and are no longer shedding virus can fully return to the workforce and keep society functioning.”

Two types of serological tests for coronavirus immunity are being evaluated by the Centers for Disease Control and Prevention. Still more tests of this type have been developed in China and Singapore, and epidemiologists like Bedford say such tests will be key to locking down the virus for good.

“Together, I believe these (and other case-based) strategies can bring down the epidemic,” Bedford said.

The key steps in the strategy – the easy availability of tests for the virus, the system for analyzing masses of cellphone location data and the tests for immunity – have yet to be nailed down. But laying out the plan in this way might at least give folks outside the research community a better sense of the big picture, and maybe give them fresh cause for hope as well.

Here’s Bedford’s 19-tweet thread, including charts and links:

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